Xardiopulmonary bypass (CPB) leads to activation of the coagulation and fibrinolytic cascades, partially associated with foreign surface contact. Hemorrhage and the need for blood products is associated with rising cost and increased risk of infection. Treatment with surface modifying additives (SMA) has been shown to reduce thrombogenicity and improve biocompatibility. 76 elective CABG-patients were randomly assigned to surface modifying additives (group I, n=39) or untreated circuits that were otherwise identical (group II, n=37). Measurements of coagulation activity and fibrinolysis, platelet count and function were made. The postoperative blood loss and blood product replacement was also assessed. Thrombin formation measured by prothrombin fragments 1+2 (5.7+/-0.4 nmol/l vs. 5.6+/-0.4 nmol/l), fibrinolytic activity measured by plasmin-antiplasmin complex (1752.6+/-216.8 microg/l vs.1180.0+/-74.8 microg/l) and the postoperative platelet count and function did not differ significantly between the two groups. Blood loss and transfusion requirements were slightly lower in the SMA group. The treatment of extracorporeal surfaces with surface modifying additives does not appear to reduce coagulation disorders and bleeding after conventional CPB.
Author(s): Martens S, Matheis G, Wimmer-Greinecker G, Scherer M, Doss M, Moritz A.
in: Cardiovasc Surg. 2003 Apr;11(2):159-63.
PMID: 12664053 [PubMed - indexed for MEDLINE]
Comment – Reply to Tang.
April 21, 2003 — dossmedicalWe appreciate Dr Tang’s interest in our study and are grateful for the opportunity to answer her questions. The basis for treatment selection in our study was not elusive, but based on the decision of a surgeon to try a new management strategy. Innovation can only happen if individuals have the courage to commit themselves to a new way. We were intrigued by the assumption that our diagnosis of sternal osteomyelitis rested largely on a clinical impression and not on microbiological criteria. In the methods section we explicitely described the microbiological culture findings for all patients in both groups [1]. As the extent of infection and type of organisms were comparable in both groups, the presented data can not invalidate the comparison between these modalities. We agree that adequate wound debridement is an important corner stone for eventual successful outcome, and practice radical wound debridement of all avital and infected tissues. Repetitive wound debridement was not necessary in all but one of our patients (in the conventional group). Also, at 5 weeks follow up, after discharge from rehabilitation, none of the patients had developed late fistulas or sinus formation involving sequestrated pockets of infected or necrotic tissues. Dr Tang points out two ways in which vacuum assisted therapy contributes towards a successful outcome of a sternotomy wound infection. However, she does not mention the foremost advantage over conventional therapy, which is the accelerated formation of granulation tissue. We demonstrated that even large defects can be covered within a short period of time and additional mutilating surgery can be avoided. That is the essence of our single centre experience.
References
1. Doss M., Martens S., Wood J.P., Wolff J.D., Baier C., Moritz A. Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis. Eur J Cardiothorac Surg 2002;22:934-938
Author(s): Martens S, Matheis G, Wimmer-Greinecker G, Scherer M, Doss M, Moritz A.
in: Cardiovasc Surg. 2003 Apr;11(2):159-63.